Why Can’t I Poop?
One of my favorite topics to talk about, much to the chagrin of my family and friends, is poop. Bowel movements. Stool. S@*t. Whatever you call it, this bodily function is intimately related to our health. So much so that if you aren’t having regular, compete, comfortable bowel movements, your body’s ability to repair itself is greatly reduced.
Let’s first discuss the ideal pooping situation. You’re having a daily bowel movement (yes, every day) that is well formed, easy to pass, and feels complete. There is no abdominal pain or pressure, and no urgency. As long as they are well formed, up to 3 BM’s a day can still be considered normal.
If you’re passing stool every day, but it’s hard, dry, lumpy, or doesn’t feel compete, this is not ideal. If you’re having loose stool every other day, that’s not ideal. If you occasionally have to run to the bathroom, or have to urge to go but can’t (that’s called tenesmus, btw), this is not good. If your stool comes out in a bunch of little pieces instead of a long, smooth snake, there is some work to be done here.
Finding yourself in the “not normal pooping” category? First order of business is to fix the symptom. Then we’ll look at some underlying causes of chronic constipation, because the last thing you want to do is be on laxatives for the rest of your life!
The Long and Winding Road
Has it been a few days since your last bowel movement? My favorite supplement for constipation is magnesium oxide. It’s an osmotic laxative, which means that it pulls water into the intestines to allow stool to move. It’s extremely effective and non-habit forming, so it’s ok to take this daily for a while, until you get your root cause figured out.
Start with a small amount, 100-300 mg, in the evening before bed. If your colon isn’t moving and shaking in a few days, add a little more. Keep going until you’re having a lovely, daily, easy BM. Be careful not to add too much too fast. It builds up in your system, and you may end up with some uncomfortable diarrhea if you take too much. So go slow, and if your stool starts to get loose, take a little less.
You’ll probably find that after a while you can wean off the mag oxide, especially once you’ve dealt with your root cause. But you may still find it helpful to keep some on hand for those times when life gets the best of you and your old friend constipation comes back to say hi.
Shake it Up Baby, Now
I’ve got 3 more supplements for you to consider adding to the pot, to address some of the other issues that could be going on behind the scenes.
First up, digestive enzymes. If you’ve been on antacids or PPI’s, you’ve been stressed, or are getting older, this can decrease your body’s ability to make the enzymes that break down your food. Low stomach acid and enzyme production causes gas, bloating, and you guessed it, constipation. To remedy this, you’ll need to take something with each meal to help your body break it down.
Digestive bitters are my favorite way to address this issue, because the mix of bitter herbs stimulates your body’s own enzyme production. You’ll get the best results if you take it as a tincture and actually taste the bitter flavor.
If you prefer, you can experiment with taking a good quality, broad spectrum digestive enzyme with each meal. Or you might find that a Betaine HCl with pepsin helps you more.
My second and third supplement rec’s are a probiotic and/or a prebiotic. If your gut issues are caused by an imbalance in your intestinal microbiome, taking the right probiotic can help to inoculate your bowel with some beneficial bacteria.
A prebiotic, on the other hand, gives the bacteria that’s already there some good quality food. Prebiotics are usually made of special types of fiber or resistant starch, like partially hydrolyzed guar gum (PHGG) or acacia fiber. Taking a prebiotic daily will feed your microbiome, allowing the good guys to grow and thrive.
Everybody Poops
Most constipation advice starts and ends with drinking lots of water, eating enough fiber, and exercising. It’s true, the poop trinity is important for ensuring your daily trip to the throne. So, check yourself and make sure you’ve got the basics covered.
Drink about 64 oz. of water daily, and load up your plate with colorful fruits and veggies, whole grains and legumes, all of which contain multiple types of fiber to keep you regular. And some type of exercise is non-negotiable. Even a daily 20 minute walk is enough to keep your gut happy.
But these suggestions are 3rd on the list – not first – for a reason. First of all, they take time to work, and sometimes you’re desperate and need to do something now. Also, I’m guessing you’ve probably already tried them, and aren’t having much success. I still felt the need to include the basics though, because in the long run you need to be doing at least this much for anything to work long term.
Think About What You’re Tryin’ To Do To Me
If you’ve made it this far, my guess is that you’re well hydrated, full of fiber, and doing daily yoga squats. You’ve probably already added a probiotic and some enzymes to your daily routine. And you still need the damn magnesium to poop!
Looks like it’s time to do some deep digging. There are quite a few serious conditions that cause chronic constipation as a side effect, and to get things moving you’ll have to address the root cause. Some of these issues include hypothyroidism/Hashimoto’s thyroiditis, SIBO or other gut dysbiosis, or even chronic Lyme disease. Let’s take a look under the hood.
Thyroid Issues
Your thyroid regulates so many functions in the body that we don’t have time to list them all. One of those functions is bowel transit time, otherwise known as the length of time it takes for something you eat to make it all the way through your digestive tract and out the other end.
In a hyperthyroid state, where your thyroid is making more hormone than is necessary, we see loose stools and diarrhea, along with insomnia, anxiety and palpitations. But most women who have a thyroid issue actually have an underactive thyroid, which instead causes constipation.
About 90% of diagnosed hypothyroidism is actually Hashimoto’s thyroiditis, an autoimmune form of hypothyroidism. In addition to constipation, you may also notice sudden weight gain, fatigue and brain fog, hair loss, a change in menstrual cycles, or depression. Another thing to keep in mind, if you notice symptoms that are swinging from hypothyroid to hyperthyroid – this could also be the beginning of Hashimoto’s.
If you experience a few of these symptoms on a regular basis, it’s time to see your doctor for a full thyroid panel, including TSH, fT3, fT4, and thyroid antibodies. If the tests come back positive, treating your hypothyroid will help regulate your bowels.
Intestinal Dysbiosis and SIBO/IMO
Another root cause of chronic constipation is an imbalance in your gut bugs. This could mean a lack of beneficial bacteria in your large intestine, an overgrowth of not so good bacteria, or the ratio of species of bacteria could be off. Dysbiosis could also mean an overgrowth of yeasts like candida, or some parasites or protozoa growing in your colon.
You could also have an overgrowth of bugs in your small intestine. See, the large intestine is home to trillions of gut bugs that help you digest food and keep you healthy. But the small intestine should be relatively free of bacteria. When bacteria grow in your small intestine they eat your nutrients and create gas as a byproduct. This can cause very uncomfortable bloating, and also leads to changes in bowel movements. This is called SIBO, or Small Intestine Bacterial Overgrowth. The same thing can happen with bugs that are called archaea, which produce methane gas. Methane will cause more severe constipation. It used to be called SIBO-C (for constipation), or methane SIBO, but recently this condition has earned its own moniker: IMO, or Intestinal Methanogen Overgrowth.
How do you know if you’ve got some unwelcome bugs making a home in your digestive tract? A SIBO breath test that looks for both hydrogen (which bacteria release) and methane can be done, either in your doctor’s office or at home. And to check your colon? A DNA PCR stool test is the best option to get a complete picture of what bugs are hanging out in your large intestine. This is something that a functional health practitioner will need to order for you.
Lyme Disease
You might think it odd for Lyme disease to make it on a list for root causes of constipation, and when I first heard of this, I was skeptical too. But then I experienced it myself, and the pain is real!
Lyme disease is caused by the bacteria Borrelia burgdorferi, which is transmitted by ticks. And it is becoming more and more common. It is called the great imitator, because once the bacteria has infiltrated your body it can cause various symptoms that look like other diseases. If you’ve been diagnosed with fibromyalgia, chronic fatigue, an autoimmune condition, a mental health disorder, POTS, or IBS, it’s possible that the underlying cause could be a chronic Lyme infection.
The borrelia bacteria likes cool, dark places, so it burrows into your joints and/or your nervous system. If it makes its way to into your intestinal nerves it can paralyze them, causing constipation. You’ll probably also notice other symptoms as well, like fatigue and brain fog, muscle, joint, and/or nerve pain that travels around the body, sleep and hormone issues, and much more.
Unfortunately, getting a diagnosis can be challenging for multiple reasons. Your best bet is to look for a Lyme literate doctor who knows what tests to run and how to interpret them. A few quick tips: skip the 2-tier ELISA testing (which misses up to 50% of cases) and go straight to the Western Blot. Even though the CDC requires 5 positive bands, if you have fewer, more specific bands, that could qualify you for a Lyme diagnosis. Also, you may want to consider treating for Lyme for about 6 weeks and then testing for it. This will wake up the bacteria so your body will produce the antibodies that the test looks for.
It Takes One to Know One
The big takeaway here is that this could be a very simple issue, or one that’s more complex. If you’ve cleaned up your diet, upped your hydration, added some supplements, and you’re still struggling, it’s time to see a good health practitioner who knows how to find and treat your root cause.
Author:
Dr. Elizabeth Williams, DACM, LAc, is an acupuncturist, herbalist, and Doctor of Chinese medicine. She is the founder of Women’s Wellness Movement, an online community of women dedicated to improving their health naturally. Her work includes reproductive health, gut imbalances, mental health, complex chronic illness, and the ways these interact uniquely in each individual.
Dehydration can cause all kinds of acute and chronic symptoms. Some, like headaches and constipation, are familiar friends. But it’s less known that chronic dehydration of cells and tissues in your body can cause the feeling you get when you feel “old”. Like when you’re stiff and creaky getting out of bed in the morning, not able to remember things like you used to, and that general sense of feeling toxic or inflamed. It would seem then, that the best way to feel younger and more energetic is to drink more water. Boy I wish it were that simple. But as I’ve (and perhaps you’ve?) experienced, gulping extra water mostly just leads to more trips to the bathroom.